Abstract:

Sleep - related rhythmic movement disorder (RMD) is characterized by repetitive,stereotyped and rhythmic motor behaviors (not tremors) that occur predominantly during drowsiness or sleep and involve large muscle groups. The onset of RMD is typically in early childhood, rarely continue into adolescence and adulthood. This paper retrospectively analyzed the diagnosis and treatment in a case of adult-onset RMD. A 76 -year-old male mainly presented rhythmic forehead banging during sleep. The number of forehead banging ranged from dozens to tens of seconds, pause seconds after the second attack, lasting 1 to 2 h and can not be recalled after waking up. Polysomnography (PSG) showed sleep efficiency decreased, awakening time prolonged, times of wakefulness increased, sleep structure disordered, non-rapid eye movement (NREM) 1 and 2 sleep increased, rapid eye movement (REM) sleep decreased, sleep latency of REM prolonged. Apnea hypopnea index (AHI) was 8.40. Several abnormal behavior attacks were observed, each attack lasting 3 to 18 s, 0.60 to 1.20 Hz, total time lasting 6 min. The diagnosis was RMD, clonazepam 0.50 mg/night and pramipexole 0.0625 mg/night were given and the result of 33 months follow-up showed effective. By literature review, we know the clinical features, diagnosis and treatment of RMD. We also analyze the reasons of misdiagnosis for reducing diagnostic errors and mistreatments.

Key words: Sleep disorders, Movement disorders, Adult

摘要：

睡眠相关节律性运动障碍是一组以躯体大组肌群重复性、刻板性、节律性动作为特征的疾病，主要发生于开始睡眠时和睡眠中，婴幼儿期发病常见，持续至成年或成年期发病者罕见。本文回顾分析1 例成人期发病的睡眠相关节律性运动障碍患者的诊断与治疗经过。男性患者，76 岁，临床主要表现为睡眠中节律性敲打前额部，发作时敲打数下至数十下不等、停顿数秒后再次发作，持续1 ~ 2 h，清醒后不能回忆。多导睡眠图监测显示，睡眠效率降低，夜间觉醒次数增加、觉醒时间延长，睡眠结构紊乱，非快速眼动睡眠期1 和2 期比例增加，快速眼动睡眠期比例减少、潜伏期延长，睡眠呼吸暂停低通气指数为8.40；可见数次异常行为发作，每次发作持续3 ~ 18 s、频率0.60 ~ 1.20 Hz，总发作时间6 min。临床诊断为睡眠相关节律性运动障碍，予氯硝西泮0.50 mg/晚和普拉克索0.0625 mg/晚规律服用33 个月，效果良好。同时复习相关文献，有助于提高睡眠相关节律性运动障碍的诊断与治疗水平，减少漏诊和误诊。

关键词: 睡眠障碍, 运动障碍, 成年人